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“An estimated 500,000 pregnancies in the United States each year involve women who have or who will develop psychiatric illness during the pregnancy.”

Think about that. Half a million women each year.

We know about 1 in 4 Americans suffer from mental disorders, 15-20% of American women suffer from depressive symptoms DURING pregnancy, and that depression during pregnancy is a global issue. Clearly, psychiatric disorders during pregnancy are common, and in my experience are not acknowledged nearly often enough.

Depression is a symptom of pregnancy seen all over the globe, and most moms do just fine. Is it fun? No, but that’s why it’s called depression. It is the opposite of fun. Does that preclude you from carrying a pregnancy to term? No. Can we connect the dots to say that if women who experience temporary mental illness shouldn’t be stopped than women who experience semi-permanent mental illness shouldn’t be impeded from carrying to term? Yes, yes we can. [President Obama gets a shout out after all the women’s health love at the DNC. Though I’m pretty sure he would still be afraid to have one of us AGers go up on stage.]

“Mental competence” in pregnancy is surely often an excuse stemming from socially unjust motivations to prevent a pregnancy from going to term. Its more socially acceptable for some people to be a parent than others. Poor people, shouldn’t parent. Rich people, should parent. Some folks have too few kids, others too many. Women contending with mental illness shouldn’t. Not because they are inherently incapable, but because they are disenfranchised. These cases are not about mental capabilities, but about privilege. Social injustice is the determining factor here. This is just another realm where we see the same patterns replicated, only with different excuses.

What is perhaps most strange to me, is that there is a cultural dialogue about postpartum depression, see: Gwyneth Paltrow’s confession, but almost no external discussion of depression during pregnancy. We are all so beholden to the image of the glowing orb of sunshine pregnant person, there is no space for an alternative leaving women without models and information. We need to create this space, and we need to make sure to discuss mental health at-large.

The two major stories I’ve seen make their way through the reproductive health circuits (which does not mean there are not more) are one of a young schizophrenic woman was who ruled mentally incompetent, and her parents forced her to have an abortion and be sterilized against her will. The ruling was made on the basis that if the young woman, Mary Moe, were “mentally competent” she would have sought an abortion. The other is thankfully slightly more uplifting. Here a woman pro-actively chooses to stop taking her mental health medication to pursue a pregnancy to term and paid a full-time babysitter to keep her from hurting herself. We need to hear more of these stories, or really the half a million women grappling with mental illness (in a wide range of forms), each year during pregnancy need to hear these stories. They need to know they are not alone. That there are women in situations more difficult than themselves, and women who have made conscious choices after considering their options (and that this is something they can be empowered to do too). We especially need models for dealing with depression during pregnancy, which is the most common illness faced.

Now we got that out of the way, what about the women who decide to continue using medications for mental disorder during their pregnancy? Though the scientific evidence is still limited, the results are tentatively promising, but women still need to be educated about the risks of drugs on themselves and the fetus, and enabled to make decisions for themselves. But there is a clear need for more research, especially studies longer periods of over time. In the interim, if you decide not to go off your medication, you are not without alternatives to care. However, many women are faced with slightly more complicated medical circumstances and often run from doctors who either says your only choices are to go off/not start medication or have an abortion, which happens. It is very common for women with mental illness to be untreated because they are pregnant, not just untreated with medication, but unable to get a spot at a psychiatric hospital. So everything I said about alternative care is true, to the point you can actually access it. Which without access, it all goes out with the baby and the bath water and we are left back where we began with disenfranchisement through social injustice.

Remember the 500,000 pregnancies are affected each year, in the US. It could easily be you one day sitting across from a doctor leaving you a choice between an abortion or your necessary medication, and simply ignoring your choice to carry to term in the best way you deem fit.